WQ0003626_ORC Designation Form_20240821

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
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Facility Name: Maxton Plant and Silgan Can Company WWTF Permit # WQ0003626
Facility Type/Classification: SI Q Facility Grade: N/A E] SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Campbell Soup Supply Company L.L.C. / Mark Rogers
Email Address: mark [e-mail]
Permittee Signature: / ^¢r Date:
ORC
Full Name: Mwy Elizabeth Ward Work Phone:
Email Address: [e-mail]
Certificate Type: SI 0 Certificate Grade: _N/A _ 0 Certificate #:
_(910) 844-1202
1015344
Signature: �At* � � U Effective Date: Oq D k I o-)_
"I certify that 1 agree to my designatio s the Operdtbr in Responsible Charge for the facility noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Full Name
Jeffrey L Scott
Backup ORC
Work Phone: [phone]
Certificate Type: Sl 0 Certificate Grade: N/A _ 0 Certificate #: 1001485
Signature: fU-"f C Z?7"_ Effective Date: e/ a2 //,7-4/
"I certify that I agree to m desi at n as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Full Name: Jimmie Lewis Britt
Certificate Type: SI El
Backup ORC
Work Phone: [phone]
Certificate Grade: N/A 0 Certificate #: 1006722
Signature:i Effective Date:
"1 certify that I agree to designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rule and regulations
pertaining to the respon bilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Email this form to: [e-mail]
AND
Send to your DEQ Regional Office (send to your contact or find emails here: www.deq.nc.gov/about/contact/regional-offices
or fax using this drop down list: Choose DWR Regional Office that has coverage of this facility.
Use the 2nd page only if you need to list additional Backups.
Revised 0212024

Facility Name: Maxton Plant and Silgan Can Company WWTF Permit M WQ0003626
Backup ORC /�
Full Name: +!� V�1� Work Phone: -1i 044
Certificate Type: Select Sk Certificate Grade: Select t'—� Certificate M (p L-k D
Signature: Effective Date:_ FC_ 2
"I certify that I agree to my de �7athon as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPC5000"
Backup ORC
Full Name: _ Work Phone:_
Certificate Type: Select Certificate Grade: Select Certificate M
Signature: Effective Date:
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and foiling to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Signature: Effective Date:
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate H:
Signature: Effective Date;
"1 certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Revised 0212024